A new scientific statement from the American Heart Association warns that heart failure symptoms in pregnant and postpartum women are often mistaken for common pregnancy discomforts, leading to dangerous delays in diagnosis and treatment. The statement, published in the journal Circulation, notes that nearly 1 in 4 women aged 20-44 currently have some type of cardiovascular disease, and heart disease is now a leading cause of pregnancy-related death in the U.S.
Heart failure symptoms such as shortness of breath, fatigue, and swelling in the legs and feet are also common in healthy pregnancies, making it easy for both patients and clinicians to overlook the condition. "Heart failure during and after pregnancy is often hiding in plain sight," said Dr. Demilade A. Adedinsewo, chair of the statement writing group. "By recognizing symptoms earlier and initiating appropriate treatment, especially in the postpartum period, clinicians and health systems have a powerful opportunity to prevent serious complications and save mothers' lives."
The statement emphasizes that the first year after delivery is a particularly high-risk time for women to develop heart failure. Some women first experience symptoms within days of childbirth, while others develop them weeks or months later. The condition, which includes peripartum cardiomyopathy (PPCM), can affect women with or without pre-existing heart disease. Risk factors specific to the perinatal period include older maternal age, multiple gestation, use of assisted reproductive technology, and prolonged use of tocolytic agents.
Delays in diagnosing heart failure can have devastating consequences. Pregnant women with heart failure are about 32 times more likely to die around the time of delivery compared to those without the condition. Other risks include irregular heartbeat, stroke, preterm delivery, and poor outcomes for the baby, such as low birth weight or stillbirth.
Significant racial disparities exist. Black adults have about a 19% higher risk of developing heart failure than white adults, and Black women with PPCM are more likely to be diagnosed later than other racial groups. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
The statement calls for standardized screening, prompt diagnostic testing (including electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms), and coordinated care between obstetricians and cardiologists—a multidisciplinary approach often referred to as cardio-obstetrics. For postpartum women, continued monitoring beyond the traditional six-week checkup is crucial, including home visits, telemedicine, and remote monitoring.
"Improving postpartum care is essential to protecting maternal health," said Adedinsewo. The statement also highlights the importance of counseling on contraception, noting that long-acting reversible contraceptives such as hormonal intrauterine devices are preferred for women with heart failure, while estrogen-containing methods are not recommended due to increased thrombosis risk.
